Non Alzheimer’s Dementia. Kevin Overbeck, DO Assistant Professor UMDNJ –SOM NJISA . Non-Alzheimer’s Dementia. This medical student presentation is offered by the New Jersey Institute for Successful Aging.
Non Alzheimer’s Dementia
Kevin Overbeck, DO
UMDNJ –SOM NJISA
This medical student presentation is offered by the New Jersey Institute for Successful Aging.
This lecture series is supported by an educational grant from the Donald W. Reynolds Foundation Aging and Quality of Life program.
Image Source: Weiss BD. Elder Care: A Resource for Interprofessional providers. http://aging.medicine.arizona.edu Accessed: October 5, 2011.
Patient with Known or Suspected Memory Loss
Identify Underlying Cause of Delirium & Treat
Equivocal or Inconsistent with Depression
Consistent with Depression
Treat Depression or Discuss Options
Re-evaluate After Treatment
Hachinski Ischemic Index highlights clinical features
Scores > 7 suggest vascular dementia
Also of note: patients with vascular dementia are more likely to have impaired executive function than those with AD
Note: All FTD is associated with a serotonergic deficit and decreased dopaminergic activity has been described; acetylcholinesterase activity is relatively intact
Photo: Microsoft Office Images #MP900448297 by Fotolia (http://office.microsoft.com/en-us/images/)
A 68 year old male presents to subacute rehabilitation following a fall and subdural hematoma. A diagnosis of FTD was made two years prior to the incident via neuropsychological testing.
Despite much improved mobility and function back to baseline, he was “made” long term care at a local nursing home, due to poor safety awareness (primarily concerns about wandering).
Admission MMSE 21/30 (deficits noted below)/abnormal CDT 2/4
“I want to see what I can do about getting out of here?” He would go to report that his wife is taking his money and “she’s trying to divorce me you know.”
Very often a visit from his wife (or a telephone call) was the only thing that could calm him down.
Other behaviors were collecting towels, poor hygiene.
Then… he ate my sandwich.
Weiss BD. Elder Care: A Resource for Interprofessional providers. http://aging.medicine.arizona.edu Accessed: October 5, 2011.
An 81 year old former PhD psychologist is transferred to assisted living from her independent living home due to significant increased deficits in her functional status – including multiple falls, inability to self-administer medications, a reversal of the sleep-wake cycle, and profound weight loss
During the next four weeks there is stabilization of the sleep-wake cycle and weight gain (112 lbs)
During the next year, despite several falls that responded to physical therapy she continues to need considerable more help dressing as well as orientation/cuing (i.e. meals and medication times). Observation from nursing is that she is just “lost” and even ostracized by other residents.
On two separate occasions she reported that she saw a mouse running across the ceiling. It was investigated in earnest but no evidence of mice could be found.
She is transferred to a specialized dementia unit in which her behavior (now observed more closely) is vastly different than other’s with Alzheimer’s dementia.
One year later (+) cogwheel rigidity is noted.
- Dominant inheritance (1 parent with gene) - CAG
- Choreoathetosis starting at 35-45 years of age
- Dementia & emotional lability also